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Comparative Outcomes of Acute Type B Aortic Dissection and Intramural Hematoma: Implications for Surgical and

Byeng Hun Jeon1, Tae Hong Yoon1, Kyung Ho Kim1

  • 1Department of Thoracic and Cardiovascular Surgery, School of Medicine, Daegu Catholic University, Daegu, Republic of Korea.

Annals of Vascular Surgery
|November 12, 2025
PubMed

Insights

Acute type B aortic syndrome (ATBAS), encompassing aortic dissection (AD) and intramural hematoma (IMH), shows distinct natural histories. While thoracic endovascular aortic repair (TEVAR) improves remodeling, it does not enhance survival for either condition.

Area of Science:

  • Cardiovascular Medicine
  • Vascular Surgery
  • Radiology

Background:

  • Acute type B aortic syndrome (ATBAS), including type B aortic dissection (AD) and intramural hematoma (IMH), often follows shared management guidelines.
  • However, limited comparative data exist regarding their distinct natural histories and outcomes.

Purpose of the Study:

  • To compare the clinical characteristics, management, and aortic remodeling patterns of patients with AD and IMH.
  • To evaluate the long-term outcomes of medical management versus thoracic endovascular aortic repair (TEVAR) in ATBAS.

Main Methods:

  • Retrospective review of 131 patients with ATBAS (52 AD, 79 IMH) treated between 2008 and 2025.
  • Stratification into interventional (TEVAR) and medical management groups.
  • Serial computed tomography (CT) assessment of aortic growth using standardized protocols and regression analysis.

Main Results:

  • IMH patients were older than AD patients (70.6 vs. 60.5 years).
  • Medically managed patients with AD showed a higher rate of delayed intervention (13.5%) compared to IMH (6.7%), primarily due to progressive enlargement.
  • TEVAR improved aortic remodeling in both AD and IMH but did not significantly impact survival rates. Aortic diameter changes correlated with false lumen or hematoma thickness.

Conclusions:

  • AD and IMH exhibit different remodeling patterns despite similar management guidelines.
  • Conservative management is effective for selected uncomplicated cases.
  • TEVAR offers remodeling benefits without survival improvement in ATBAS, though early intervention may be beneficial for progressive AD.
Abstract

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